Experiences using an SMS service for ART adherence among pregnant and postpartum women living with HIV in Kenya: A qualitative analysis

Abstract

Purpose: Understanding the experiences of pregnant and postpartum women living with HIV receiving standard text messages (SMS) to encourage ART adherence can help elucidate the benefits and limitations of SMS for adherence in this population. We aimed to understand the experiences of pregnant and postpartum women living with HIV (WLWH) in Kenya during their experience with the Mobile WAChX trial. Methods: Semi structured individual interviews were conducted among women (n=44) who received bidirectional or unidirectional SMS and were exiting the Mobile WAChX trial. This trial was an unblinded, three-arm randomized controlled trial examining the effect of unidirectional and bidirectional combined HIV and maternal child health (MCH) text messages on ART adherence during pregnancy and up to 2 years postpartum. Participants were recruited via purposive stratified sampling. Transcripts were coded by two investigators and analyzed using the Information-Motivation-Behavioral Skills (IMB) framework. Deductive thematic analysis was also performed to understand the challenges experienced by the women during the intervention. Results: Women overall reported a positive experience with the SMS intervention. There were 5 key themes that emerged. First, SMS provided reminders and skills for medication adherence and clinic appointments. Second, SMS served as a significant source of social support and motivation for adherence-related behaviors. Third, SMS provided hope for living a normal life. Fourth, SMS reduced feelings of internalized and anticipated stigma and increased feelings of courage and self-acceptance. Lastly, participants experienced technical, financial, and logistical challenges to the intervention. Conclusion: Combined HIV/MCH messaging was well received by participants and provided them informational and psychosocial support. Challenges experienced by participants that could not be overcome with SMS included the daily financial stressors that participants faced as well as technical challenges. Our study highlights the potential for mHealth to intervene on stigma related barriers to adherence and retention in care. Further research is needed to understand the challenges that impede consistent ART adherence among pregnant and postpartum women living in Kenya.